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�� MARION COUNTY PUBLIC WORKS <br /> • <br /> ��I �� 1�))1)" BUILDING INSPECTION DIVISION <br /> �..�y��`� 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503) 588-5147 Fax(503) 588-7948 <br /> MARION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, RAINES, ALAN L , have authorized <br /> (Property Owner/Print Name) <br /> 3-A Construction, LLC. to act as my agent in performing the <br /> (Authorized Representative/Print Name) <br /> activities necessary to obtain site evaluations,permits, and other onsite wastewater treatment program <br /> services provided by the Department of Environmental Quality or County Agent on the property <br /> described below in accordance with OAR chapter 340, division 071. <br /> PROPERTY IDENTIFICATION: <br /> 560 W NORTH SANTIAM HW GATES, OR <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 093E27DB Tax Lot#(s)00200 <br /> PROPERTY OWNER: <br /> Printed Name: Raines,�y Alan L <br /> Signature: —12 nL o014;105416o1PoT) Date: 06/24/24 <br /> Address: P.O. box 793 Phone: 5035510231 <br /> City, State,Zip Mill City OR 97360 Fax: <br /> E-mail Address rainesboy9@gmail.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Jesus Andrade <br /> Company Name: 3-A Construction, LLC. CCB # 167959 DEQ 39002 <br /> Signature: VC47' Date: 06/24/2024 <br /> Address: 1690 Harvey ST SE Phone:9712183568 <br /> City, State, Zip Jefferson OR 97352 Fax: <br /> E-mail Address info@3aoregon.com <br /> DEQ License# 39002 CCB# 167959 <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />